Provider Demographics
NPI:1003204322
Name:HOBART NURSING AND REHAB
Entity Type:Organization
Organization Name:HOBART NURSING AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-715-6759
Mailing Address - Street 1:9 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-8462
Mailing Address - Country:US
Mailing Address - Phone:479-715-6759
Mailing Address - Fax:479-715-6922
Practice Address - Street 1:709 N LOWE ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651-1642
Practice Address - Country:US
Practice Address - Phone:479-715-6759
Practice Address - Fax:479-715-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH3803-3803314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375279Medicare Oscar/Certification